Appendix A Features of Acute Chest Pain Features of Persistent Chest Pain that Suggest ACS • Cardiac chest “pain” is usually described by the patient as an unpleasant sensation in the chest: “pressing”, “squeezing”, “constricting”, “bursting”, “burning”, “a band around the chest”, “a weight in the centre of the chest” or a “vise tightening around the chest”. Clenching the fist in front of the sternum (Levine’s sign) is a strong indication of an ischemic origin of the pain. • It is important to note that the sensation is often not described as being severe. The discomfort may radiate or be completely isolated to the neck, jaw, teeth, epigastrium, shoulder or arms (most commonly the left). It is frequently associated with shortness of breath, diaphoresis, weakness, nausea and vomiting, and occasionally associated with gas, belching or “indigestion”. • The discomfort may be partially or fully relieved by nitro-glycerine, but may not respond to nitro- glycerine at all. There may or may not be a prodrome of the discomfort precipitated by exercise, cold weather or emotional stress relieved by rest or nitro-glycerine. • Chest discomfort that lasts for more than 10 minutes or occurs at rest suggests unstable angina; chest discomfort that lasts for more than 20 minutes suggests acute myocardial infarction. An acute coronary syndrome may present with acute shortness of breath with or without evidence of chest pain. Features of Chest Pain that do not Suggest ACS • Pain or discomfort that is localised to the skin or chest wall and can be reproduced by localised pressure. • Pain that is localised to a small area of the chest (< 3 cm in diameter), or pain that radiates to the right lower chest. • Pain that is sharp, stabbing or knifelike and aggravated by deep breathing or rotating the chest. • Pain that is worse in the supine position and relieved by sitting up or leaning forward is suggestive of pericarditis. • Pain that lasts for less than 15 seconds is rarely ischemic in origin. • Dissection of the aorta often causes pain in the back in addition to the front of the chest. BRITISH COLUMBIA MEDICAL ASSOCIATION Guidelines & Protocols Advisory Committee Ministry of Health Services
Features of Acute Chest Pain
Sep 05, 2022
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Acute Chest Pain - Evaluation and Triage - Appendix A Features of Acute Chest PainAppendix A Features of Acute Chest Pain
Features of Persistent Chest Pain that Suggest ACS • Cardiac chest “pain” is usually described by the patient as an unpleasant sensation in the chest:
“pressing”, “squeezing”, “constricting”, “bursting”, “burning”, “a band around the chest”, “a weight in the centre of the chest” or a “vise tightening around the chest”. Clenching the fist in front of the sternum (Levine’s sign) is a strong indication of an ischemic origin of the pain.
• It is important to note that the sensation is often not described as being severe. The discomfort may radiate or be completely isolated to the neck, jaw, teeth, epigastrium, shoulder or arms (most commonly the left). It is frequently associated with shortness of breath, diaphoresis, weakness, nausea and vomiting, and occasionally associated with gas, belching or “indigestion”.
• The discomfort may be partially or fully relieved by nitro-glycerine, but may not respond to nitro- glycerine at all. There may or may not be a prodrome of the discomfort precipitated by exercise, cold weather or emotional stress relieved by rest or nitro-glycerine.
• Chest discomfort that lasts for more than 10 minutes or occurs at rest suggests unstable angina; chest discomfort that lasts for more than 20 minutes suggests acute myocardial infarction. An acute coronary syndrome may present with acute shortness of breath with or without evidence of chest pain.
Features of Chest Pain that do not Suggest ACS
• Pain or discomfort that is localised to the skin or chest wall and can be reproduced by localised pressure.
• Pain that is localised to a small area of the chest (< 3 cm in diameter), or pain that radiates to the right lower chest.
• Pain that is sharp, stabbing or knifelike and aggravated by deep breathing or rotating the chest.
• Pain that is worse in the supine position and relieved by sitting up or leaning forward is suggestive of pericarditis.
• Pain that lasts for less than 15 seconds is rarely ischemic in origin. • Dissection of the aorta often causes pain in the back in addition to the front of the chest.
BRITISH COLUMBIA
MEDICAL ASSOCIATION
Features of Persistent Chest Pain that Suggest ACS • Cardiac chest “pain” is usually described by the patient as an unpleasant sensation in the chest:
“pressing”, “squeezing”, “constricting”, “bursting”, “burning”, “a band around the chest”, “a weight in the centre of the chest” or a “vise tightening around the chest”. Clenching the fist in front of the sternum (Levine’s sign) is a strong indication of an ischemic origin of the pain.
• It is important to note that the sensation is often not described as being severe. The discomfort may radiate or be completely isolated to the neck, jaw, teeth, epigastrium, shoulder or arms (most commonly the left). It is frequently associated with shortness of breath, diaphoresis, weakness, nausea and vomiting, and occasionally associated with gas, belching or “indigestion”.
• The discomfort may be partially or fully relieved by nitro-glycerine, but may not respond to nitro- glycerine at all. There may or may not be a prodrome of the discomfort precipitated by exercise, cold weather or emotional stress relieved by rest or nitro-glycerine.
• Chest discomfort that lasts for more than 10 minutes or occurs at rest suggests unstable angina; chest discomfort that lasts for more than 20 minutes suggests acute myocardial infarction. An acute coronary syndrome may present with acute shortness of breath with or without evidence of chest pain.
Features of Chest Pain that do not Suggest ACS
• Pain or discomfort that is localised to the skin or chest wall and can be reproduced by localised pressure.
• Pain that is localised to a small area of the chest (< 3 cm in diameter), or pain that radiates to the right lower chest.
• Pain that is sharp, stabbing or knifelike and aggravated by deep breathing or rotating the chest.
• Pain that is worse in the supine position and relieved by sitting up or leaning forward is suggestive of pericarditis.
• Pain that lasts for less than 15 seconds is rarely ischemic in origin. • Dissection of the aorta often causes pain in the back in addition to the front of the chest.
BRITISH COLUMBIA
MEDICAL ASSOCIATION
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